Denial Prevention Process Improvement Specialist I

Mass General Brigham • Somerville, MA

3d • Remote

About The Position

As a member of the Denial Prevention Team, the Denial Prevention Process Improvement Specialist will drive continual improvement efforts to prevent insurance rejections and related write offs. Responsible for analyzing, designing, and implementing process improvement initiatives to enhance the quality of patient care, operational efficiency, and patient safety by identifying areas for improvement, streamlining processes, and promoting a culture of continuous improvement within the hospital.

Requirements

• Bachelor's Degree in a related field of study required
• 1-2 years of process improvement/quality management experience preferred
• Strong data analysis and statistical skills to interpret performance data and identify trends.
• Familiarity with healthcare operations, patient care processes, and healthcare quality standards.
• Excellent communication and interpersonal skills to collaborate with various stakeholders and present findings and recommendations.
• Strong problem-solving and critical-thinking skills to identify process issues and implement effective solutions.
• Proficiency in project management to lead and coordinate improvement projects from initiation to completion.
• Skilled in Excel functions, formulas, and pivot tables.

Responsibilities

• Utilize knowledge of revenue cycle and hospital operations to interpret denial data, identify trends and translate findings into actionable prevention strategies.
• Analyze existing denial prevention healthcare processes, workflows, and procedures to identify inefficiencies, bottlenecks, and areas for improvement.
• Develop and implement performance metrics and key performance indicators to measure process effectiveness and track improvement initiatives.
• Lead or participate in quality improvement projects to optimize patient care, patient safety, and healthcare outcomes.
• Gather and analyze data related to process performance, patient outcomes, and other quality-related indicators to inform improvement efforts.
• Conduct root cause analysis to identify the underlying factors contributing to process issues or adverse events.
• Collaborate with cross-functional teams to design and implement redesigned processes that are efficient, standardized, and aligned with best practices.
• Facilitate change management efforts to ensure successful implementation of process improvements and promote staff buy-in.
• Continuously monitor and evaluate the effectiveness of implemented improvements and make adjustments as needed.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level